Briefing paper

NHS performance and waiting times: priorities for the next government

National Health Service (NHS) Public health Medicine United Kingdom

NHS waiting time performance has dominated public and political debate since the late 1990s. In 1999, more than 50,000 people were waiting more than a year for hospital treatment – it is now just over 1,000. It was the 1999 death of a 38-year-old patient in the north of England, on a waiting list for cardiac surgery, that galvanised the Labour government to inject more money into the NHS, at growth rates not repeated since.

Essential parts of the NHS in England are experiencing the worst performance against waiting times targets since the targets were set. While it is important to look at other aspects of the quality of care beyond waiting times, the persistently downward trend against these targets is a barometer of the wider pressures the health and social care system is facing. It is a signal that the NHS is unable to meet patient needs with the resources it has available.

Key points:

  • Essential parts of the NHS in England are experiencing the worst performance against waiting times targets since the targets were set. This includes the highest proportion of people waiting more than four hours in A&E departments since 2004, and the highest proportion of people waiting over 18 weeks for non-urgent (but essential) hospital treatment since 2008.
  • The target for treating cancer patients within 62 days of urgent GP referral has not been met for over 5 years, and survey evidence suggests more people are experiencing lengthening delays in getting GP appointments.
  • Longer waits are a symptom of more people needing treatment than the NHS has the capacity to deliver. This reflects a decade of much lower than average funding growth for the NHS and workforce shortages, coupled with growing and changing population health needs. These pressures are exacerbated by cuts to social care and public health budgets, which make it harder to keep people healthy outside hospitals.
  • It will take sustained investment in the NHS and social care to reverse lengthening waits. This will include filling existing staff vacancies and growing the workforce, investment in buildings and equipment, and stabilising the social care sector.
  • If the NHS is to achieve its long-term vision of a service that can prevent ill-health, better manage long-term conditions, and treat people earlier, NHS staff will need time, space and skills to make change at all levels of the health and care system.  
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